This study identified and characterized a group of schizophrenic patients without neuropsychological (NP) impairment. A comprehensive NP battery was administered to 171 schizophrenic outpatients and 63 normal comparison participants. Each participant's NP status was classified through blind clinical ratings by 2 experienced neuropsychologists; 27% of the schizophrenics were classified as NP normal. The NP-normal and NP-impaired schizophrenics were similar in terms of most demographic, psychiatric, and functional characteristics, except that NP-normal patients had less negative and extrapyramidal symptoms, were on less anticholinergic medication, socialized more frequently, and were less likely to have had a recent psychiatric hospitalization. The existence of NP-normal schizophrenics suggests that the pathophysiology underlying the cognitive deficits often associated with schizophrenia may be distinct from that causing some of its core psychiatric features.

In the treatment of chronic schizophrenia, there are risks associated with both neuroleptic maintenance (eg, tardive dyskinesia) and neuroleptic withdrawal (eg, psychotic exacerbation or relapse). We reviewed 66 studies on neuroleptic withdrawal involving 4365 patients with schizophrenia. The mean cumulative relapse rate was 53% in patients withdrawn from neuroleptic therapy and 16% in those maintained on neuroleptic therapy over a mean follow-up period of 9.7 months. The relapse rate was positively associated with length of follow-up. Predictors of relapse reported in individual studies included younger age, higher baseline neuroleptic dosage, and shorter length of hospitalization. Adverse effects of neuroleptic withdrawal other than relapse were usually mild and transient. The risk-benefit ratio of neuroleptic maintenance vs withdrawal should be assessed carefully in individual patients. A slow taper to the lowest effective dosage may be the preferred strategy in many patients.From the

Onset of schizophrenia after the age of 40 has been a controversial topic. We reviewed more than 30 publications (mainly from Europe) on this subject. Many of the studies had methodological shortcomings, including problems in precisely dating the onset of schizophrenia. Nonetheless, it appears that a certain proportion of patients present for the first time with diagnosable schizophrenia after age 40. Late-onset schizophrenia is characterized by paranoid symptomatology, a high female:male ratio, an elevated prevalence of hearing loss and ocular pathology, schizoid or paranoid traits in premorbid personality, a tendency toward chronicity, and symptomatic improvement with neuroleptics. Family studies suggest that the prevalence of schizophrenia in relatives of late-onset schizophrenic probands is higher than that in the general population, but lower than that in relatives of earlier-onset schizophrenic probands. We believe that late-onset schizophrenia is a valid entity (or group of entities). Studies of the course, biological associations, neuropsychological performance, and pharmacological characterization of late-onset schizophrenia are warranted.

The atypical antipsychotic risperidone is significantly less likely to result in TD than the conventional neuroleptic haloperidol in a high-risk group of older patients, at least over a 9-month period.

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